In addition to the history and physical exam, myocardial ischemia may be associated with ECG changes and elevated biochemical markers such as cardiac troponins. Patients can present with chest discomfort or pressure that can radiate to the neck, jaw, shoulder, or arm. Prolonged deprivation of oxygen supply to the myocardium can lead to myocardial cell death and necrosis. With coronary artery occlusion, the myocardium is deprived of oxygen. Most myocardial infarctions are due to underlying coronary artery disease, the leading cause of death in the United States. Myocardial infarction may be'silent,' and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death. Myocardial infarction (MI), colloquially known as 'heart attack,' is caused by decreased or complete cessation of blood flow to a portion of the myocardium.
